Report | Question ID | Question | Discussion | Answer | Year |
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20190027 | Extent of Disease 2018/Primary tumor/Neoadjuant treatment: If there is no clinical information available and all that is available is the post-neoadjuvant information, is it better to code EOD unknown (999) or use the post-neoadjuvant information to code EOD? See Discussion. |
The Extent of Disease (EOD) Manual states: Neoadjuvant (preoperative) therapy: If the patient receives neoadjuvant (preoperative) systemic therapy (chemotherapy, immunotherapy) or radiation therapy, code the clinical information if that is the farthest extension documented. If the post-neoadjuvant surgery shows more extensive disease, code the extension based on the post-neoadjuvant information. |
Code EOD Primary Tumor using the post neoadjuvant information for this case. Since the only information you have is the post neoadjuvant, code that. EOD combines clinical and pathological information. |
2019 |
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20190075 | Sex: How should the sex field be coded for the newly allowable non-binary gender designation ? See Discussion. |
Washington State added to birth certificates, which allows people to have their certificates changed to this non-binary gender designation. Gender X is defined as a gender that is not exclusively male or female, including, but not limited to: intersex, agender, amalgagender, androgynous, bigender, demigender, female-to-male, genderfluid, genderqueer, male-to-female, neutrois, nonbinary, pangender, third sex, transgender, transsexual, Two Spirit, and unspecified. |
Code Gender X as 9 when that is the only information available. Use text fields to document the details. Also refer to coding instruction #7. When gender is not known Assign code 1 when the primary site is C600 'C639 Assign code 2 when the primary site is C510 'C589 Assign code 9 for primary sites not included above |
2019 |
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20190009 | First Course Treatment/Surgery of Primary Site--Breast: How is "Goldilocks," also referred to as oncoplastic reconstruction, in the surgery section for breast cancer patients coded? |
Code Goldilocks mastectomy in Surgery of Primary Site. Breast surgery code 30 seems to be the best available choice for "Goldilocks" mastectomy. It is essentially a skin-sparing mastectomy with breast reconstruction. The choice between code 30 and codes in the 40-49 range depends on the extent of the breast removal. Review the operative report carefully and assign the code the best reflects the extent of the breast removal. |
2019 | |
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20031133 | First Course Treatment--Thyroid: Is hormone replacement following total thyroidectomy coded as first course treatment for all thyroid cases? | Code Hormone therapy as 01 [Hormone therapy administered as first course therapy] when thyroid replacement therapy is part of the first course of treatment for follicular or papillary thyroid cancer following thyroidectomy. Thyroid hormone replacement therapy has a treatment effect on differentiated (follicular and papillary) carcinomas of the thyroid. This treatment effect is not seen for most medullary and undifferentiated thyroid cancers. |
2003 | |
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20230040 | First Course Treatment/Hormone Therapy--Prostate: Is Lupron first course therapy in a patient who initially elected active surveillance for prostate cancer and then consented to treatment with Lupron? See Discussion. |
in March, the patient with stage cT1c, Gleason grade 7, prostate cancer elected active surveillance. In April, the patient consented to treatment with Lupron. There was no evidence of disease progression. According to the rules on page 161 of the 2023 SEER manual, we think the answer is yes, but the reporting hospital states that this is second course therapy. |
Code Lupron as second course therapy and code active surveillance as first course therapy in this scenario. The 2023 SEER Manual states to code all treatment data items to 0 or 00 (Not done) when the physician opts for active surveillance, deferred therapy, expectant management, or watchful waiting. Assign code 2 to Treatment Status. Active surveillance is not the same as "refusing treatment." Active surveillance is a valid option offered to the patient. The patient chose this option and later changed their mind. This is not a refusal of recommended treatment. Document all the details in the appropriate treatment text fields. |
2023 |
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20150026 | First course treatment--Breast: When Lupron is given as cancer-directed treatment for metastatic breast cancer, should it be coded as Hormone Therapy or Other Therapy? See Discussion. |
Per the SEER*Rx Database, Lupron is coded as Other Therapy for breast cancer until such time that it receives FDA approval. However, SINQ 20021042 states Lupron should be coded as Hormone Therapy when given as cancer-directed therapy. These two sources contradict each other.
Information regarding hormone therapy for breast cancer in both the SEER*Rx Database and the National Cancer Institute's Cancer Topics website (http://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet) seem to indicate that the SINQ answer is the correct choice. The NCI Cancer Topics website states that Lupron acts to block ovarian function and is an example of an ovarian suppression drug that has been approved by the FDA. The SEER*Rx Database Remarks section states that a combination of letrozole and leuprolide (Lupron) "is considered standard treatment for metastatic breast cancer and is sometimes used for treatment of early stage breast cancer." But the Remarks go on to state that Lupron should be coded as Other Therapy until it receives FDA approval.
It is unclear how to code Lupron for breast cancers when the NCI website indicates that it is standard treatment while the SEER*Rx Database states both that it is and that it is not standard treatment. |
Code Lupron given for breast cancer in the "Other" treatment field using code 6 (other-unproven). Lupron is still not an approved hormone treatment for breast cancer and should not be coded in the hormone field.
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2015 |
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20091002 | Multiplicity Counter--Ovary: Given the diffuse nature of ovarian cancer, should we count bilateral parenchymal involvment of ovaries as two tumors? See Discussion. |
Are peritoneal implants mets and not counted as separate tumors, even though they're not stated to be metastatic in the path report, and are not coded as distant mets? |
Code Multiplicity Counter to 02 [Two tumors present] for an epithelial ovarian primary involving both ovaries. Do not count the peritoneal implants; they are regional metastasis and not included in the multiplicity counter. An example like this will be added to the manual in the next revision. |
2009 |
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20180112 | Solid Tumor Rules (2018)/Histology--Lung: What is the histology code of a non-small cell lung cancer (NSCLC), NOS as this is not on the AJCC list of histologies? See Discussion. |
A question was posted to CAnswer forum 9/26/18 and answered stating that 8046 is not on the AJCC list of histologies for the lung chapter in the 8th edition. If the final diagnosis on the pathology report is just NSCLC, NOS with no subtype/variant, what histology/solid tumor rule would I use? In this situation, I am not able to query the pathologist. Would I code the histology to 8010 as per AJCC post? |
Code NSCLC to 8046/3. Do not change a histology code simply to assign TNM to the case. AJCC does not determine histology coding. While pathologists are no longer encouraged to use NSCLC, it does not mean the term and code are obsolete. NSCLC could be any number of histologies such as adenocarcinoma or squamous carcinoma. A diagnosis of NSCLC indicates that the initial exam of the tissue did not identify a more specific type of NSCLC. Additional immunohistochemical testing is needed to determine the histology. Update the case if better information becomes available from subsequent tests/review. When analyzing the data, researchers and physicians will be able to identify the cases where the pathologist was unable to or did not perform further testing to determine a specific histology which drives treatment and survival. |
2018 |
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20180031 | First Course of Treatment/Other Therapy: Where do you code Optune TTF therapy? What needs to be included in the text portion to document this treatment? |
Code OPTUNE in the Other Treatment field. See NovaTTF in SEER*Rx (http://seer.cancer.gov/seertools/seerrx/). NovaTTF is the pre-FDA approval name for OPTUNE. If OPTUNE was administered for recurrence, be sure NOT to record it in the first course of treatment fields. Check with CoC if you have questions about coding treatment for recurrence. |
2018 | |
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20230064 | Primary Site--Cervix Uteri: When no other information is available regarding the origin of the tumor, can an overlapping cervical adenocarcinoma (C538, 8140/3) be coded to the endocervix (C530) based on the histology? See Discussion. |
Adenocarcinoma is a glandular tumor and the endocervix is generally the origin of glandular tissue for the cervix. However, if the only available information is pathology proving a single tumor overlapping the endocervix and exocervix, can we code the site to C530 instead of C538? Applying the current primary site coding instructions, primary site would be coded as C538 because there is no specific statement of the tumor origin; the primary site coding instructions state the tumor is coded to an overlapping site in the absence of a specific statement of origin and there is no existing SINQ confirming the site can be assumed to be the endocervix based on the histology. |
Code Primary Site as Overlapping lesion of cervix uteri (C538). The 2023 SEER Program Coding and Staging Manual Primary Site Coding Instructions for Solid Tumors #4 says to code the last digit of the primary site code to ‘8’ when a single tumor overlaps an adjacent subsite(s) of an organ and the point of origin cannot be determined. This is also supported by the ICD-O-3, 3rd edition, note in the Topography section that states: In categories C00 to C809, neoplasms should be assigned to the subcategory that includes the point of origin of the tumor. A tumor that overlaps the boundaries of two or more subcategories and whose point of origin cannot be determined should be classified to subcategory ‘8.” |
2023 |